Total alloplastik temporomandibular eklem protezi etrafında gelişen heterotopik ossifikasyonun tedavisi: olgu bildirimi

Year 2018, , 87 - 91, 14.08.2018

Onur Yılmaz , Burak Cezairli , Celal Çandırlı

https://doi.org/10.17214/gaziaot.323079

Abstract

Tanıtım:
Temporomandibular eklem (TME) ankilozu durumlarında uygulanan total eklem protezi
replasmanı erken dönemde fonksiyonu geliştirir ve reankiloz olasılığı oldukça
azdır. Ancak nadiren TME protezi etrafında gelişen heterotopik kemik
formasyonuna bağlı reankiloz meydana gelebilir. Bu durumda kemik kitlesi rezeke
edilir ve protez yeniden uygun pozisyonda yerleştirilir. Ankiloz cerrahisi
sonrasında artiküler yüzeylere yağ grefti uygulanmasının fonksiyonu
geliştirdiği ve reankiloz olasılığını azalttığı belirtilmektedir.

Olgu Bildirimi: Daha önce sol
TME ankilozu nedeniyle total alloplastik TME protezi uygulanan hasta, ağız
açıklığında kısıtlılık ve ağrı şikayetiyle kliniğimize başvurdu. Yapılan klinik
ve radyolojik değerlendirme neticesinde TME protezi etrafında heterotopik kemik
formasyonu geliştiği gözlendi. Genel anestezi altında preaurikular
yaklaşım ile TME protezi açığa çıkarıldı. Temporomandibular eklem protezi
atravmatik olarak uzaklaştırıldı ve heteretopik kemik kitlesi rezeke edildi.
Ardından TME protezi uygun pozisyonda yerleştirildi ve artiküler yüzeylere
otojen yağ grefti uygulandı. İki yıllık takipte herhangi bir reankiloz bulgusuna
rastlanmadı.

Sonuç: Reankiloz gelişen vakalarda kemik kitlesinin
rezeksiyonunun ardından uygulanan interpozisyonel otojen yağ grefti rekürrens
olasılığını azaltır ve çene fonksiyonlarını geliştirir.

Keywords

Ankiloz, heterotopik ossifikasyon, temporomandibular eklem

Treatment of heterotopic ossification developing around total alloplastic temporomandibular joint prosthesis: case report

Abstract

Introduction:
Total joint replacement applied in temporomandibular joint (TMJ) ankylosis
improves function in the early period and significantly reduces the likelihood
of reankylosis. However, reankylosis may rarely occur due to heterotopic bone formation around the TMJ
prosthesis. In this situation, the bone mass is resected and the prosthesis is
repositioned in the proper position. It has been reported in previous
studies that the application of fat graft to the articular surfaces after the
ankylosis surgery improves functionality and reduces
the likelihood of reankylosis.

Case Report: A
patient with total alloplastic TMJ prosthesis that had been applied due to
ankylosis of the left TMJ was admitted to our clinic with complaints of pain
and limitation in mouth opening. Heterotopic bone
formation around the TMJ prosthesis was observed through clinical and
radiological examinations. Under general anesthesia, the TMJ prosthesis was
exposed via preauricular approach. The TMJ prosthesis was removed
atraumatically and the heterotopic bone mass was resected. The TMJ prosthesis
was then placed in the appropriate position and autogenous fat graft was
applied to the articular surfaces. No signs of reankylosis were observed during a two-year follow-up.

Conclusion: Autologous interpositional fat graft applied after the resection of the
bone mass in cases which develop reankylosis reduces the likelihood of
recurrence, and improves jaw functions.

Keywords

Ankylosis, heterotopic ossification, temporomandibular joint

References

• Clauser LC, Consorti G, Elia G, Tieghi R, Galie M. Management of temporomandibular joint reankylosis in syndromic patients corrected with joint prostheses: surgical and rehabilitation protocols. Craniomaxillofac Trauma Reconstr 2014;7:71-8.
• Kaban LB, Bouchard C, Troulis MJ. A protocol for management of temporomandibular joint ankylosis in children. J Oral Maxillofac Surg 2009;67:1966-78.
• Singh V, Dhingra R, Bhagol A. Prospective analysis of temporomandibular joint reconstruction in ankylosis with sternoclavicular graft and buccal fat pad lining. J Oral Maxillofac Surg 2012;70:997-1006.
• Mercuri LG, Ali FA, Woolson R. Outcomes of total alloplastic replacement with periarticular autogenous fat grafting for management of reankylosis of the temporomandibular joint. J Oral Maxillofac Surg 2008;66:1794-803.
• Keller EE, Baltali E, Liang X, Zhao K, Huebner M, An KN. Temporomandibular custom hemijoint replacement prosthesis: prospective clinical and kinematic study. J Oral Maxillofac Surg 2012;70:276-88.
• Dimitroulis G, Slavin J, Morrison W. Histological fate of abdominal dermis-fat grafts implanted in the temporomandibular joint of the rabbit following condylectomy. Int J Oral Maxillofac Surg 2011;40:177-83.
• Mercuri LG. Alloplastic temporomandibular joint replacement: rationale for the use of custom devices. Int J Oral Maxillofac Surg 2012;41:1033-40.
• Topazian RG. Comparison of gap and interposition arthroplasty in the treatment of temporomandibular joint ankylosis. J Oral Surg 1966;24:405-9.
• Dimitroulis G. A critical review of interpositional grafts following temporomandibular joint discectomy with an overview of the dermis-fat graft. Int J Oral Maxillofac Surg 2011;40:561-8.
• Mercuri LG. Considering total temporomandibular joint replacement. Cranio 1999;17:44-8.
• Selbong U, Rashidi R, Sidebottom A. Management of recurrent heterotopic ossification around total alloplastic temporomandibular joint replacement. Int J Oral Maxillofac Surg 2016;45:1234-6.
• Guarda-Nardini L, Manfredini D, Olivo M, Ferronato G. Long-Term Symptoms Onset and Heterotopic Bone Formation around a Total Temporomandibular Joint Prosthesis: a Case Report. J Oral Maxillofac Res 2014;5:e6.
• Huggins CB. The phosphatase activity of transplants of the epithelium of the urinary bladder to the abdominal wall producing heterotopic ossification. Biochem J 1931;25:728-32.
• Wolford L, Movahed R, Teschke M, Fimmers R, Havard D, Schneiderman E. Temporomandibular Joint Ankylosis Can Be Successfully Treated With TMJ Concepts Patient-Fitted Total Joint Prosthesis and Autogenous Fat Grafts. J Oral Maxillofac Surg 2016;74:1215-27.
• Durr ED, Turlington EG, Foote RL. Radiation treatment of heterotopic bone formation in the temporomandibular joint articulation. Int J Radiat Oncol Biol Phys 1993;27:863-9.
• Mercuri LG, Saltzman BM. Acquired heterotopic ossification of the temporomandibular joint. Int J Oral Maxillofac Surg 2017 Jul 12. pii: S0901-5027(17)31526-6. doi: 10.1016/j.ijom.2017.06.016. [Epub ahead of print]
• Wolford LM, Morales-Ryan CA, Morales PG, Cassano DS. Autologous fat grafts placed around temporomandibular joint total joint prostheses to prevent heterotopic bone formation. Proc (Bayl Univ Med Cent) 2008;21:248-54.
• Blair VP. Operative treatment of ankylosis of the mandible. Trans South Surg Assoc 1913;28:435.
• Murphy JB. I. Arthroplasty for intra-articular bony and fibrous ankylosis of the temporomandibular articulation. J Am Med Assoc 1914;62:1783-9.
• Wolford LM, Karras SC. Autologous fat transplantation around temporomandibular joint total joint prostheses: preliminary treatment outcomes. J Oral Maxillofac Surg 1997;55:245-51; discussion 51-2.